Comrades!

Feel glory in the wonderful opportunity that central government has given you. Your inability to reach the required number of 'Amber' calls in the mandatory time has resulted in a new and innovative plan to allow intellectuals to shine.

We are to cut your budget by £1.6 million, thus allowing you to 'think smarter' in order to reach these same goals in time for next year's auditing.

As that cute white kitty says 'hang in there baby' for while some of the proletariat may see this as a 'punishment' rest assured that this is no such thing. By cutting your budget we will enable innovative practice to flourish. By placing this obstacle in the path of providing world class healthcare we will be 'evolutioning out' poor ideas and this burning of the forest of old ideas will enable new sprouts of innovative innovation to sprout sproutlike from the bed of innovation.

True, the valued, committed, diverse and hard-working staff of the organisation may suggest that the nineteen minute target to reach these 'Amber' calls is not based on any clinical or scientific evidence - however we leave it to LAS management to design some eye-catching and diverse posters explaining that it is the public's perception of the service that is more important than anything approaching clinical need.

May we suggest that any roadstaff that suffer a break in morale should be moved to East London where the constant influx of deeply sub-healthy and not-up-to-standard education patients will remind the staff that they are truly lucky to be working for such an innovative, forward thinking and diversely diverse organisation.

Those who complain about a lack of blankets and blood sugar machines should be shot as an example to the others.

We look forward to seeing the innovation that your staff create - might I suggest hiring a few new managers at £70k salaries a shot to facilitate the innovation?

Yours faithfully (and innovationingly),

The government.

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Seriously, we've just had our budget cut by £1.6 million (it was supposed to be £3 million but the fine was reduced after some begging negotiation) over our inability to hit the 'Amber 19' target. That is reaching a certain percentage of our 'Amber' calls in nineteen minutes or less. Again this target number is not based on any sort of, I dunno, evidence. Instead it is based around what the public demand.

Ho-hum. That'll help with the shortage of blankets, vehicles and other rather useful kit that I find missing from my ambulance whenever I start a shift.

Here we go...

Ambulance service gets £38 for every patient they don't take to hospital

Patients' groups expressed horror at the "sick experiment" in which NHS managers have agreed to pay £38 for every casualty that ambulance staff "keep out of Accident and Emergency" (A&E) departments after a 999 call has been made. The tactic is part of an attempt to manage increasing demand for emergency care amid failings in the GP out-of-hours system.

Documents seen by The Sunday Telegraph disclose that staff at Britain's largest ambulance service have been encouraged to maximise the organisation's income, by securing payments for diverting patients to telephone helplines. The bonuses are among dozens of schemes being tried out by ambulance trusts across the country as they attempt to improve their emergency response times and help A&E departments meet controversial targets to treat all patients within four hours of arrival. Another plan uncovered would see thousands of 999 calls currently classed as urgent downgraded so that callers receive telephone advice instead of an ambulance response.

I suspect that, once again the journalist writing this has no idea on the sorts of pressures any ambulance service is dealing with.

Our own figures show that only 10% of calls are 'life-threatening', (Taking healthcare to the patient: Transforming NHS ambulance services p8 3.4).

That is why our calltakers prioritise calls by using a computer system. We simply do not have enough ambulances to deal with the 4,000-5,000 calls we get per day.

80% of the calls to us do not require hospital treatment. Eight out of ten calls to us are for things like coughs and colds, vomiting once in a day, hangovers, headaches, period pains, cut fingers, sprained ankles, feeling hot, feeling cold and of course the plethora of 'drunk and asleep in the street'.

Now, I'm not saying that the process is perfect - far from it, there are plenty of failings of which I've written about in the past. Grannies with broken femurs are a lower priority than a drunk asleep in the street - and the main claim to fame about the computer triage system that we use is that 'it has never been successfully sued in America', and that is, sadly, a large part of the problem.

(That and the calltakers are not trained, or allowed, to vary from the script the computer gives them to read).

In the past two shifts I have been sent on numerous 'blue light' calls to drunks asleep in the street ('unconscious/not alert'), some people with colds ('difficulty in breathing'), Can't sleep ('Not alert'), Drank alcohol ('Overdose - not alert') and Fallen - bruise on thumb ('Fall - not alert'). In the last two shifts I can't think of one patient that actually required my attendance, or hospital treatment. Needless to say all the 'not alert' people were very much alert when I walked into the room and had to try and pick my patient out of a family group of the twelve people crowding into the living room.

So, why did I take them to hospital? It's because I'm not trained to leave people at home and I know that I won't get any support should that person die. I'm far from the only ambulance person with this point of view.

So, the people who commission ambulance services are looking to save the money that is currently spent on treating these non-emergency cases in hospitals. I'm not against this, after all it's my tax money that goes towards treating these non-emergency calls, and A&E treatment is expensive. It's why the government is intent on shutting down as many A&E departments as it thinks it can get away with.

So the PCTs have taken the decision that, rather than spend £100-200 per A&E hospital visit, it would be cheaper to reward the ambulance service they commission with £38 if we can either leave such cases at home, or direct them to a better place to deal with their 'illness'.

It seems sensible when 80% of our calls don't need emergency hospital treatment.

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Now, I'm going to take a quick break to admit that this isn't ideal. The infrastructure for people with sub-acute chronic conditions to be treated at home isn't there at the moment. That is, for example, the ability to be treating people with long term heart failure or emphysema at home is not, in my opinion, up to scratch.

In this blog post I'm talking purely about 'emergency' cases - the coughs and colds brigade as it were.

-----

With road staff unwilling to leave people at home in all but the most minor cases due to lack of support/training and a general culture of 'I won't lose my job or get sued if I take someone to hospital' it fell to Control to do a large part of the triage.

And so it was the 'Clinical Telephone Advice' desk came into being.

This is a desk with specially trained road staff who, when passed a call that is a low priority (in other words it has been through the normal computer triage system and therefore we aren't going to get sued), will ring back the patient and will talk to them and use some clinical judgement as to the best course of action for that patient.

So, for example, Mr. 'I've had a runny nose for three days, I can't get a GP appointment please send me a wahmbulance because I've run out of tissues' (and yes, I do get sent to those calls) will be triaged as not having chest pain, difficulty in breathing or any other priority symptom, and so the CTA desk will phone him back, determine that he has a cold and will advise him to suck it up and act like a man for a change.

(OK, OK, they'll probably advise he phones NHS direct or a trip to the pharmacist for some over the counter meds, but you get my drift).

Meanwhile, on the road, I'll have been sent a mobile phone mast to start driving towards (in case it turns into a 'Cat A' call) , then get sent the address I'm actually needed at, then get cancelled as the call goes to the CTA desk.

If you ever see an ambulance doing perpetual U-turns in the street, this is the reason why.

By saving the NHS £400 by not sending an ambulance who then cart him off to an A&E department, the ambulance service will receive £38 to spend on, I don't know, blankets or something.

This all makes sense, right?

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It all comes down to the question of, how much taxes would you like to pay for what degree of service?

If you want an ambulance on every street, well, that's £40,000+ for the ambulance, plus a couple of thousand for the kit inside it, £26,000 for me to sit in it for 37.5 hours a week, multiply that wage by at least six for 24 hour coverage, add in money for fuel, insurance, training of staff, the wages of those to take your phone call, etc, etc, etc...

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Moving on to the 'Another plan uncovered would see thousands of 999 calls currently classed as urgent downgraded so that callers receive telephone advice instead of an ambulance response.'

Yes.

Hell yes.

We massively over-prioritise our calls. It's why drunks in the street get a priority just short of 'dad's stopped breathing, help us please!'. All calls that we get from the police - often 'person has small cut / person needs to be checked out / person 'in shock') are automatically 'amber calls'. That's a blue light response every time.

Small cut to the head, that's a Red call as it is 'bleeding to potentially dangerous area'.

Period pain? Amber response please as it is 'Serious bleeding'.

Crying because you are upset? - Red call as you obviously have 'difficulty in breathing'.

Twenty year old with a pain in his chest from coughing too much - Red call 'Chest pain'.

Blocked nose? - Red call as you have 'difficulty in breathing'.

None if these need an ambulance, but because of the triage system that is forced upon us we have no choice.

(Meanwhile granny with 'broken leg, after a fall' is a Green call - we'll get to you when we have finished dealing with all of the above... or if one of our sensible allocators is working and upgrades the call.)

We need, as a priority, to juggle the priorities that we give calls - based on the evidence that we have collected from 4,000+ calls a day over a number of years, otherwise we just aren't able to cope with the influx of 'can't get a GP' calls.

In fact recently, Peter Bradley, our CEO chaired a meeting that proposed this - and he still got turned down.

(The government seems to adore ignoring evidence and just going it's own way - so I chose to ignore the bullshit they tell me.)

So downgrading 'puncture wound, peripheral artery' seems reasonable to me - because that, right there, is your 'I cut my finger on a lid of a cat food tin', it's not someone getting stabbed and dying in the street.

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Needless to say I don't get to see any of these £38 'bonuses', and that is almost certainly for the better, otherwise road staff would take more risks at leaving patient's at home.

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The problem simply boils down to this - like it says on the side of the ambulance we are an 'Accident and emergency' service, we should not be a replacement for GPs, we should not be used because someone can't be bothered to wait for a GP appointment, we should not be called at 1am in the morning because someone has had a 'high blood pressure for the last week'.

But people will use us like that because they want 'things' to be 'sorted out immediately with no waiting'.

Our ' core business' is A&E work, and yet we are being forced to be a medical everyman, without the funding, the infrastructure and the training - and a large part of this is based around the government not understanding that because someone has an apparently minor illness like a headache, a minimally trained ambulance worker can rule out the sorts of things that doctors train for eight years to rule out. Am I a neurologist? Can I tell the difference between a migraine, meningitis or a brain tumour?

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And tomorrow I'll tell you why our funding has been cut by £1.6 million.

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As I don't work up in Control, I'd be exceptionally happy to have any comments from Control room staff on this story - for one, I can't see how anything that is a 'collapse with difficulty in breathing' could end up going to the CTA desk as stated in that story.

'More Blood, More Sweat and Another Cup of Tea', is about to be released in what is called 'Mass Market' edition. This is a cheaper and smaller format of the book - hopefully it'll mean a bump in sales, and therefore a bump in royalties coming to me.

It's the same book, just a handier size.

It is released on April the first (yes, yes, I know...) and if I may dare to be so bold, would make a lovely gift for your loved ones, neighbours, acquaintances and random people in the street.

It's being stocked by Waterstones and Smiths and I'm keeping my fingers crossed that a supermarket or two might pick it up.

The last time I pimped my book here it shot to the #1 slot in the pre-order charts and it gave my ego a much needed massage, as well as giving my publisher a smile (which I think he needed, after all he has to put up with me).

You can pre-order it from Amazon, or if you prefer, from Waterstones.

And of course, you can download it for nothing from this fine site.

(OK, pimping done - back to the more usual whinging).

For those that are interested in how the publishing industry works - can I point you to a series of blog posts by Charlie Stross, collected for your delectation on my ebook site

When we are called to a drunk in the street we have a number of options open to us. Well, we have four options, but realistically we only have two.

Option One

Leave them where they are - either they aren't that drunk, or they have friends who will look after them. We don't do this that often as it will only take one of them to then waltz out into traffic and get their fool arse killed to lose you your job.

Option Two

Call the police. If there is nothing wrong with them then surely we should call the police, after all it's not a medical problem really is it? Realistically, it's the police who call us to get rid of the drunks and one too many death in custody cases means that custody sergeants are loathe to have drunk in their cells. I can't really blame them.

Option Three

The commonest one - take the drunken idiot to hospital, then we have been seen to have done our job in removing them to a place of safety. Of course, in many of these cases the A&E department isn't the place for them. Where we should be taking them is to a cot in a tent where minimally trained (and therefore cheap) people can look after them until they sober up.

As these places don't exist (except on special occasions like New Year's Eve in central London) the 'patient' ends up in A&E where they can cause a load of trouble for the staff and other patients.

Option Four

We take them home, we leave them with someone who is at least a little bit responsible and then make ready for our next job. It works if we know where they live and that they aren't too drunk to stand. This gets us clear of the patient quicker than if we were to take them to hospital, it frees the hospital from having to look after the person concerned, and the drunkard is safe in their own bed.

As mentioned, we don't do options One and Two, we often use option Three and we can also, at our discretion, end up using option Four a fair bit as well.

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Paramedic who gave drunk girls a lift suspended

The on-duty paramedic was caught on camera dropping five women, who were swigging from a bottle of wine, at a train station. One of his passengers even kissed him farewell as they stumbled out of the emergency vehicle in full view of hundreds of people celebrating St Patrick's Day.

"I was absolutely gobsmacked and couldn't believe what I was seeing," said Paul King, a photographer who saw the scene. "I am sure taxpayers would be delighted to know that they are paying for paramedics to operate as a free taxi service for drunken women. "It is absolutely disgusting and what worries me is the number of real emergencies that were kept waiting while this was going on." The paramedic, who has not been identified, works for private ambulance company MediForce and was contracted by the South Central Ambulance Service to provide ambulance cover in Reading on Wednesday night.

.....

"Our responder was informed by a member of the public that one of the members of a group of females was having difficulty and kept falling over around the corner from his location," he said. "He responded at normal speed to the location and found four females, one of whom was lying on the floor. He inquired if assistance was required and, after assessing that there was no injury or illness that required hospital intervention, he took the four females at normal speed without turning on his emergency lights or sirens to Reading train station so that they could make their way home safely.

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Now, like most ambulance stories in the newspapers, I'm sure there are several details missing - however, going on what has been written this 'Paramedic' (the private company only refer to him as a 'responder', not a Paramedic), seems to have done nothing different than what regular ambulance crews, certainly across London, do every night.

I'd like to direct Mr King to the years of archive material in this blog to show him that I am often used as a 'free taxi', by drunks and non-drunks alike.

It seems to me that the responder did nothing wrong, and in fact acted with full duty of care. Certainly I would have done much the same in the same situation.

(Well... Actually I'm not brave enough to have drunk women alone in a car with me - just in case one of them makes an allegation against me. It's happened to crews in the past and I've been threatened with it myself. It's one of the many reasons why I'm glad I've got a female crewmate).

What were his other options? Leave them in the street - then the headline would be 'Paramedic leaves my injured daughter in the street'.

Take her to hospital, despite not needing to go?

Wait for an ambulance to come and take her to hospital? Thereby tying him and the ambulance up with a rubbish job when they could be going to see one of those 'real emergencies' that I've heard about but haven't personally seen in the last four months.

I'm no fan of private ambulance services doing 999/A&E work - and if I had the motivation I'd do an exposé on what the coming privatisation of the ambulance service will mean for patient care. But in this case the responder did a sensible thing, his company even say he did things for the drunk's safety.

...and still ends up suspended.

(I suspect he wouldn't have been suspended if the newspapers hadn't got a hold of this non-story).

I always though I had to watch out for being punched, stabbed or run over - looks like the biggest danger to my career is someone talking to a newspaper.

It's getting harder for me to blog because I'm trying to not lose my sanity.

You see, this blog has been a place for me to tell stories but it has also been a place for me to get angry - to shout about crappy social care, uncaring and criminal nursing homes, the misuse of our service and, indeed, the mistakes that I think the government and our own management have made.

But of late I've come to realise that getting angry about things doesn't matter, not really.

I can shout all I like, rant and rave, fill in paperwork and publicise things on this blog - and the net result of all that energy, strain and anger is precisely nil.

So I've been working on not getting angry anymore about things that I cannot change.

No blankets on my ambulance - not my fault.

No essential medical kit on my ambulance - I'll muddle along without, but it's not my fault.

Being sent on 'active area cover' 800 yards from the station - So what if it's almost certainly against the policy I'll meekly go there like a lamb.

Someone dials 999 because they've had a blocked nose for three hours? - Fine, come on to my ambulance and I'll drive you to A&E where you can wait for hours.

I'll try not to listen to the desperate calls for ambulances to go to a fitting child.

You dialled 999 because you want 'treatment' for the headache you've had for the past hour - sure, I'll point out that it says 'Emergency' on the side of the ambulance and not 'GP', 'Pharmacy', or 'Most things get better left alone'. Then I'll take you to hospital and you can sit in a noisy, brightly lit waiting room for three hours and fifty minutes.

When the drunk with the cut to his head turns violent, or walks off, I'm not going to struggle with them to get them into my ambulance.

Basically I'm worn - nothing I do has any wider effect than the comfort that I can give to the patient in front of me and their relatives. If I keep worrying and getting angry I'm going to lose my head.

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So, I shall continue to treat my patients to the best of my ability with the equipment that I have to hand and the training that I have been given - and to stop worrying about the big picture.

The only downside to this is that, without the passionate hatred of where things are going so obviously wrong, I'm finding it hard to be motivated to write blog posts.

After all it's a bit tricky to write something interesting about a young man calling an ambulance because he vomited once.

And so this is my 'excuse' as it were as to why my blogging has been light of late.

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I'm also somewhat fed up about double standards.

A paramedic who lied about his failure to try to revive a collapsed heart attack victim on a 999 call was jailed for a year today.

That's lied about something - still very wrong, but really? A year in jail?

Especially when you look at this,

A Rotherhithe woman received a suspended sentence after attacking a paramedic and police officer who tried to assist her. Kate Ibrahim, 30, of Tawny Way, pleaded guilty, having changed her plea since a previous appearance, to two counts of assault.

Or even this little charmer - who, if I met in the course of my work I'd have to call sir...

A joyrider has walked free from court after killing a police dog and injuring two officers in a road smash while three times over the drink-drive limit. As his 12-month prison sentence was suspended at Newcastle Crown Court, Sean Lawson, 20, shouted ‘Get in!’

I don't know - I just feel like buggering off to a remote island somewhere and letting people get on with it.

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My comment on the paramedic jailed for lying, because a lot of people have asked is simple - if he'd said that he couldn't start resuscitation because of the size of the patient and the cramped environment he'd probably have been fine. I don't really see the point of lying about it, at the end of the day the police and the coroner would have understood (and this is why I suspect he's been jailed for lying rather than for manslaughter or similar.

Still, he's got a year to think about it.

Sorry folks, another crosspost from Paper Not Included, my mea culpa this time is that I'm recuperating from a pair of nightshifts that were less that smooth. Something ambulance based tomorrow though.

Windowing makes ebooks more like DVDs than CDs

I got into a discussion on Twitter last night with someone who I respect about ebooks, made slightly difficult by constraining myself to 140 characters and by fitting my tweets around work. And it being silly o'clock in the morning when my brain turns, not so slowly, to mush.

He was suggesting that when you buy a hardback book there is within it a 'scratch panel' with a code for the ebook version. While I completely agree with the idea, and it has been one I've suggested in the past, I was trying to make the point that, especially when ebooks are concerned, the publishing industry isn't exactly the most sane creature.

For the record, I don't think that publishers will want to do this because it is too easy to buy the book and then email the code to someone else - or put it on a 'book swap' website where such codes could change hands. The publishers would then see this as a 'lost sale' and therefore 'lost profit' rather than as a marketing tool.

Our brief discussion then turned to whether ebooks are to MP3s as physical books are to CDs.

I maintain that ebooks are to DVDs as physical books are to films at the cinema.

You see, the publishing industry, like the film industry has long had a point of 'windowing' releases. That is, a film is released in the cinema - stays around for a few weeks and then only after a few months does the film get released as a DVD or digital download.

On the other hand, CDs are normally released at the same time as MP3 downloads.

Turning to publishing, like films at the cinema - hardback books are released first and it is only much later they are released as a paperback book.

This is known as 'windowing', and it is used to ensure that one section of the market, the section that is willing to pay more for first access, or for the 'experience', don't instead decide to turn to a less profitable product.

In the publishing world the profit margin on a hardback is much more than that on a paperback (although the risks are greater), it is a poorly held secret that while hardbacks cost three times that of a paperback they do not cost three times as much money to make and distribute.

This then is why many publishers are looking at a distribution scheme where the hardback is released first, and the ebook is held back until the paperback version is released, or even held back until later.

Is this sane?

Without the figures available I can only speculate - but I would imagine that the algorithm that the publishing house comes up with is perhaps lagging behind the real social change that the internet and social media has wrought.

I would guess that most people who buy hardcover books are those that simply cannot wait until the paperback to read the book by an author, or are huge fans of the experience of reading a book - the sheer physicality of a hardcover. These people will pay triple the price of a paperback for the same 'content' in order to read it as soon as possible - I know I have been that person in the past.

Then you have the second market - those that will wait until the paperback is released. This section are more wary of spending a lot of money and will happily put off that instant gratification in order to get a bargain.

The third market are those that will wait until they can borrow the book from the library, or will buy the book when it appears in a second hand bookshop. Publishers get no money from these people and so they are ignored, or marketed at in order to become members of the first or second market.

Where we stand now we have a new 'fourth market' with ebooks - people who don't care about the physicality of books and who want instant gratification. The jury is still out on how much money that they want to pay (this returns to the argument of 'how much should you pay for an ebook', do you pay near hardback prices for that instant gratification, or do you pay less because you are buying a product with less functionality?).

So, how do you window ebooks so that they don't gouge your physical books sales? Can you make the ebook price enough that you recoup any hardback sales lost, yet don't discourage people from paying that amount for a non-physical product?

One key question is 'how is the first market who buy hardbacks split?', Those who want the experience, the pure artifact of owning a hardcover will never buy that as an ebook as it doesn't have anything that they want. It's those that want that instant gratification that may start switching to ebooks, and publishers want to keep the profit that those people bring them.

It is simplistic to say that ebooks 'cost nothing'. Sure, the 'per unit' cost of an ebook is next to zero - once you have an ebook format you can sell a million copies for the same cost as selling a hundred copies - but the real cost is in getting to that finished ebook format. This means copyediting, author's advances, marketing and the myriad of other costs that go into making a book. It is this initial outlay that publishers look to recoup with those initial sales of hardbacks (because remember, the profit margin is higher on them).

So, what for the future?

I see publishers continuing to do one of two things, they will either 'window' their sales - making ebooks available only after the paperback version of a book is released, or they will embrace the 'variable pricing' model initially releasing an ebook at the same time as the hardback for hardback like prices. Then when the paperback is released they cut the price of the ebook for something more like a paperback price and then finally, after selling the majority of their paperback sales, they will lower the cost of the ebook even more in order to make the last bit of money from those who are only willing to pay secondhand book market prices.

This, in part, is why publishers are embracing the 'agency' model of ebook pricing that came to a head with the fight between MacMillan and Amazon, brought on in some part by the imminent release of the iPad.

Is this sane? Well it makes sense in some part - but then it ignores in part the influence of social media in book buying - and that is a subject for a later date.

The first job of the day was to 'female slipped on ice - police on scene'.

I'll admit that, at half past six in the morning my thoughts towards people, actually towards anything, are often less than charitable.

'It's not that cold', I said to my crewmate - although years of working in all weathers mean that I'm perhaps not best placed to judge, 'I bet she's found the one tiny patch of ice in Newham and fell on that'.

It's the end of the financial year, and so there are roadworks and temporary traffic lights everywhere, unbeknownst to us there was also a 'fun run' in the area - no-one had told us road staff about it. So it took a fair bit longer than normal to get to the patient.

She was stretched out on the pavement and there were four police officers standing around her. As she was partway in the road they had parked their vehicle to 'fend off' the oncoming traffic.

As we pulled up one of the police officers knocked on our window, 'be careful - it's like an icerink out here'.

Well, I have nice boots, they tend to be alright on ice, so I suspected the police officer was being a bit dramatic.

I stepped out of the vehicle and instantly felt my feet sliding under me. The officer was right - it was treacherous.

I decided to forgive our patient for falling over.

My crewmate started to assess the patient - she had a painful knee and with one gentle feel from my crewmate through the patient's jeans she knew she'd done something serious and crunchy to her knee.

Time for a stretcher then.

So, being the driver, I pulled the stretcher out and started towards the patient.

My crewmate describes the next few moments as her seeing the stretcher flying towards her, and her putting herself between the careening stretcher and the patient.

From my point of view, while moving the heavy and awkward stretcher both of my feet slipped and took off skywards. The horizon disappeared and I found myself admiring the beautiful blue sky. Then there was a crunch as I hit the floor and skidded a few inches to a halt.

I knew I hadn't hurt myself so I found myself laying there laughing.

The police officers ran over to me to make sure I was alright - I'm heavy after all and I have a lot of things in my pocket that made an awful noise as I fell on my arse.

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The rest of the job went quite smoothly, our patient was very brave despite being in a lot of pain - pain that we controlled the best we could with immobilisation of the knee and some nitrous-oxide. Further examination in the ambulance revealed something rather wrong with our patient's knee, so she needed a trip to the hospital.

My crewmate's insta-diagnosis was proven right as our patient's kneecap - normally one bone had decided to become at least six separate bones...

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As for the road, the police had got in contact with the council to come and grit this small section of road. What had happened was that the was a large puddle in a bus lane, as the night buses had gone past they had each laid a thin layer of water onto the road, these layers had then frozen, aided perhaps by the nearby river. This wasn't helped by being essentially invisible against the black of the road.

Unforeseeable and unfortunate, it was no-one's fault and it'll teach me to think ill thoughts at the crack of sparrow's fart in the morning.

Possibly.

I really like I.T - Information Technology, after all I've been using it since I was around eight years old. However, in those thirty years of using computers I'm also fully aware of some of the problems that I.T can make manifest.

Especially when you bring in the cheapest contractors, don't supervise them properly, don't consult properly with the people to be using the system and then start cutting budgets halfway through the project.

*cough* NHS *cough*

I mean, if you can't get contractors who are skilled enough to stick linoleum to the floor, how can you trust your commissioning people to find someone good enough to do invisible and arcane things with computers.

Therefore you end up doing daft things like sending letters with confidential information to the wrong people - as, despite what the 'Connecting for Health' person says, without serious thinking I can imagine two ways of a member of the public getting confidential and potentially damaging information because of these letters.

(And notice how the CoH speaks as faceless unit - the spokesperson doesn't have a name in that article)

Actually this is perhaps why we stick with outdated software - official web browser of the NHS? Internet Explorer 6.

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But I'm no Luddite - when a system works well, it works well.

Take my mum - she's currently under the care of a consultant and the consultant is juggling her medication for her. Slowly increasing the medication while looking for improvement or side effects.

Does my mum need an appointment to do this? No. The Consultant has an email address that we can send updates to, and the Consultant can suggest dose changes.

It works really well.

The problem only occurred when my mum went to the GP surgery (that has been there for some years) in order to get a refill of the prescription.

My phone rang that morning...

'Hello, it's the GP surgery, you mum has come in asking for more pills but we have no record of this - but she has told us about the emails from the consultant - can you fax the email to us please'.

Well, I haven't owned a fax machine for quite some time.

'Could I not forward the email to you? I have it on the machine I'm sitting in front of right now'.

'Sorry, no - our email isn't working yet'.

So I had to print it out and drive down to my mum's place (only five minutes and I did get a cup of tea for my trouble) with a printed out email in my hand. All because their email wasn't working yet.

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So, you can see how it works - someone embracing technology as an option (I know that email isn't hugely secure, but the important thing is that we had a choice about whether to use it or not), while another part of the NHS can't get it's email working.

Situation normal then - the luck of the draw.